Somnia Anesthesia’s first webinar of 2012, “How the Anesthesia Care Team Model Can Contribute to Clinical Quality Excellence in Your OR,” was extremely well attended and generated a large number of questions that could not be addressed during the 15-minute long Q&A session.
If you missed the webinar, you can download the entire presentation and the Q&A session by clicking here.
Below, two of the presenters address some of the questions that were not covered during the webinar. Additional questions will be addressed by Somnia’s VP of Medical Affairs, Robert Farrar, MD, JD, in an upcoming video to appear on our YouTube channel.
Frank Schramm, MD, Chief of Anesthesia
Providence Regional Medical Center
Q: In the context of the anesthesia care team(ACT) what are some of the biggest problems you have faced regarding overall management of the team? What is the biggest advantage of the hospital anesthesia care team model?
A: The most significant advantage of the ACT is the practice efficiency of the model. An Anesthesiologist-only model is significantly more expensive per patient care episode and is, typically, made up of fewer providers. The blending of the complementary skill sets of the Anesthesiologist and CRNA allows for the maximization of benefit to the patient and the facility. The Anesthesiologist is uniquely suited to the role of director and consultant charged with the optimization and preparation of the patient for the operating room as well as to the direct care of those with more critical needs. In addition the collaborative nature of the Anesthesiologist/CRNA team allows for the provision of high quality, cost efficient care with the needs of the patient being met through the blending of training and skill sets. CRNAs are well trained and frequently highly experienced in the practice of intraoperative patient management and act as “force multipliers” in the ACT. CRNAs involved in the ACT frequently benefit from access to case types which they might, in another setting, not have exposure to. The ACT model represents a true “win-win” for all stakeholders. The major problem encountered in establishing an ACT model at a facility where one has not previously existed is the overall acceptance of the presence of the CRNAs in the operating rooms.
Q: Do you get much push-back from surgeons relative to the use of the CRNA as opposed to the anesthesiologists?
A: As mentioned above, the push-back from surgeons tends to be the biggest concern with ACT model implementation. This is generally driven by fear of two things; change and the unknown. Surgeons are creatures of habit and generally become accepting of the model once they are helped to understand the structure and potential benefits inherent therein. Excellent support during startup is essential to the success of the transition; this comes in the form of pre-transition facility needs/wants assessment and provider selection using rigorous, thorough, time proven screening techniques and on-the-ground support from team members with prior transition experience during the initial implementation.
Brent Sommer, CRNA, MPHA
Desert Regional Medical Center
Palm Springs, CA
Q: Why are 10 MDs needed at your facility if you are using a 4 to 1 CRNA to MD ratio with 10 CRNAs?
A: The 4:1 ratio is an ideal and often realistic staffing goal for our particular practice arrangement. Patient and case acuity and complexity, along with particular case demands, and provider availability can all influence this ratio.
Case demands, including those scheduled in diagnostic areas such as the Cardiac Catheterization Lab, Interventional Radiology, Endoscopy Suites, MRI, CT scan, combined with Obstetrics and Trauma service needs all demand dedicated providers. These “out of OR” assignments also impacts departmental staffing and workflow ratios. Daily team management by the lead facilitator directs and manages provider assignments and overall team work flow.